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Ask the Mental Health Expert Archives 2001-2004

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Recidivism in Chemical Dependent Population

Q. I have searched the net looking for data about recidivism rates in the chemical dependency population. Do you know where I may find statistics relating to treatment outcome in substance abuse?

A. The good news is, many people with substance abuse/chemical dependency (CD) do benefit from treatment. But, as your question implies, there are many who relapse, even after treatment. For example, Kennedy et al (J Subst Abuse Treat 1993 Jul-Aug;10(4):395-406) studied 91 adolescents (74 males and 17 females, mean age = 16.5) admitted to an in-patient treatment facility with a substance use disorder. Subjects were followed over a 1-year period post-treatment. Follow-up phone interviews were conducted with each patient and a parent at 3-month intervals. At 1-year post-treatment, 47% reported complete abstinence from alcohol and other drugs. Obviously, that leaves a lot who were not completely absinent.

In a 1-year follow-up study after multimodal inpatient treatment for cocaine and methamphetamine dependencies, Frawley et al (J Subst Abuse Treat 1992 Fall;9(4):271-86) found that total abstinence from cocaine for the group as a whole was 53% at one year post treatment, and current abstinence of at least 6 months at follow-up was 68.6%. Being around other users accounted for 49% of relapse situations. The role of medication for substance abuse and CD is still somewhat unclear.

In one placebo-controlled, double-blind study of fluoxetine in severe alcohol dependence (Kabel et al, Alcohol Clin Exp Res 1996 Jun;20(4):780-4) 28 male patients with severe alcohol dependence completed a placebo-controlled, double-blind clinical trial of the antidepressant, fluoxetine [Prozac]. They were assigned to medication group in the second of 4 weeks on a voluntary inpatient chemical dependency ward and continued medication during a 12-week follow-up phase. Fluoxetine did not reduce clinically significant relapse rates. Only 8 of 15 (53%) of fluoxetine subjects remained sober at 12 weeks, compared with 9 of 13 (69%) of the placebo group. Subjects with comorbid cocaine dependence relapsed more than twice as often (3 of 4, 75%) as those with alcohol dependence alone (8 of 24, 33%).

In contrast, better results may be seen when depression is part of the CD picture. Thus, Cornelius et al. (Arch Gen Psychiatry 1997; 54:700-705) followed fifty-one depressed alcoholics for 12 weeks, after a 2- to 3-day detoxification and a subsequent 1-week washout period. Patients were then randomized in a double-blind fashion to receive either fluoxetine or placebo. A statistically significant improvement in depressive symptoms was seen in the group treated with fluoxetine versus those on placebo, as you might expect. But, interestingly, total alcohol consumption was significantly lower in the fluoxetine group than in the placebo group.

For more information about treatment outcome in CD, I suggest you contact the National Council on Alcohol and Drug Dependence at 800-475-4673, or the National Clearinghouse for Alcohol and Drug Information (http://www.health.org).

Other Resources:

August 2001
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